Medicaid Expansion bill HB 4714 as passed by the House (2013)

7/28/2019 Medicaid Expansion bill HB 4714 as passed by the House (2013)

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HB-4714, As Passed House, June 13, 2013

SUBSTITUTE FOR

HOUSE BILL NO. 4714

A bill to amend 1939 PA 280, entitled

"The social welfare act,"

by amending sections 105, 105a, 106, 107, 108, and 109c (MCL

400.105, 400.105a, 400.106, 400.107, 400.108, and 400.109c),

section 105 as amended by 1980 PA 321, section 105a as added by

1988 PA 438, sections 106 and 107 as amended by 2006 PA 144, and

section 109c as amended by 1994 PA 302, and by adding sections 105c

and 105d.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

Sec. 105. (1) The state department OF COMMUNITY HEALTH shall1

establish a program for medical assistance for the medically2

indigent under title XIX. The director of the state department OF3

COMMUNITY HEALTH shall administer the program established by the4


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state department OF COMMUNITY HEALTH and shall be responsible for1

determining eligibility under this act. Except as otherwise2

provided in this act, the director may delegate the authority to3

perform a function necessary or appropriate for the proper4

administration of the program.5

(2) As used in this section and sections 106 to 112, "peer6

review advisory committee" means an entity comprising professionals7

and experts who are selected by the director and nominated by an8

organization or association or organizations or associations9

representing a class of providers.10

(3) As used in sections 106 to 112, "professionally accepted11

standards" means those standards developed by peer review advisory12

committees and professionals and experts with whom the director is13

required to consult.14

(4) As used in this section and sections 106 to 112,15

"provider" means an individual, sole proprietorship, partnership,16

association, corporation, institution, agency, or other legal17

entity, who has entered into an agreement of enrollment specified18

by the director pursuant to UNDER section 111b(1)(c).111B(4).19

Sec. 105a. (1) The department OF COMMUNITY HEALTH shall20

develop written information that sets forth the eligibility21

requirements for participation in the program of medical assistance22

administered under this act. The written information shall be23

updated not less than every 2 years.24

(2) The department OF COMMUNITY HEALTH shall provide copies of25

the written information described in subsection (1) to all of the26

following persons, agencies, and health facilities:27


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(a) A person applying to the department OF COMMUNITY HEALTH1

for participation in the program of medical assistance administered2

under this act who is considering institutionalization for the3

person or person's family member in a nursing home or home for the4

aged.5

(b) Each nursing home in the state.6

(c) Each hospital in the state.7

(d) Each adult foster care facility in the state.8

(e) Each area agency on aging.9

(f) The office of services to the aging.10

(g) Local health departments.11

(h) Community mental health boards.12

(i) Medicaid and medicare certified home health agencies.13

(j) County medical care facilities.14

(k) Appropriate department of social services COMMUNITY HEALTH15

personnel.16

(l) Any other person, agency, or health facility determined to17

be appropriate by the department OF COMMUNITY HEALTH.18

SEC. 105C. THE DEPARTMENT OF COMMUNITY HEALTH SHALL PROVIDE A19

PROCESS BY WHICH INDIVIDUALS MAY APPLY FOR OR RENEW MEDICAL20

ASSISTANCE ELIGIBILITY THROUGH IN-PERSON ASSISTANCE, BY TELEPHONE,21

OR ON A WEBSITE FROM WHICH THE DEPARTMENT OF COMMUNITY HEALTH SHALL22

ENROLL INDIVIDUALS WHO ARE ELIGIBLE FOR THE MEDICAL ASSISTANCE23

PROGRAM OR THE MICHILD PROGRAM WITHOUT REGARD TO THE PROGRAM FOR24

WHICH THE INDIVIDUAL APPLIED. THIS SECTION DOES NOT APPLY IF EITHER25

OF THE FOLLOWING OCCURS:26

(A) IF THE DEPARTMENT OF COMMUNITY HEALTH IS UNABLE TO OBTAIN27


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House Bill No. 4714 (H-3) as amended June 13, 2013

A FEDERAL WAIVER AS PROVIDED IN SECTION 105D.1

[(B) IF FEDERAL GOVERNMENT MATCHING FUNDS FOR THE PROGRAM2

DESCRIBED IN SECTION 105D ARE REDUCED BELOW 100% AND ANNUAL STATE3

SAVINGS AND OTHER SAVINGS ASSOCIATED WITH THE IMPLEMENTATION OF THAT4

PROGRAM ARE NOT SUFFICIENT TO COVER THE REDUCED FEDERAL MATCH. THE5

DEPARTMENT OF COMMUNITY HEALTH SHALL DETERMINE HOW ANNUAL STATE SAVINGS6

AND OTHER SAVINGS WILL BE CALCULATED BY JUNE 1, 2014.]7

SEC. 105D. (1) THE DEPARTMENT OF COMMUNITY HEALTH SHALL SEEK A8

WAIVER FROM THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN9

SERVICES TO DO, AND UPON APPROVAL OF THE WAIVER SHALL DO, ALL OF10

THE FOLLOWING:11

(A) ENROLL INDIVIDUALS ELIGIBLE UNDER SECTION12

1396A(A)(10)(A)(I)(VIII) OF TITLE XIX WHO MEET THE CITIZENSHIP13

PROVISIONS OF 42 CFR 435.406 AND WHO ARE OTHERWISE ELIGIBLE FOR THE14

MEDICAL ASSISTANCE PROGRAM UNDER THIS ACT INTO A CONTRACTED HEALTH15

PLAN THAT PROVIDES FOR AN ACCOUNT INTO WHICH MONEY FROM ANY SOURCE,16

INCLUDING, BUT NOT LIMITED TO,THE ENROLLEE, THE ENROLLEE'S17

EMPLOYER, AND PRIVATE OR PUBLIC ENTITIES ON THE ENROLLEE'S BEHALF,18

CAN BE DEPOSITED TO PAY FOR INCURRED HEALTH EXPENSES.19

(B) GIVE ENROLLEES DESCRIBED IN SUBDIVISION (A) A CHOICE IN20

CHOOSING A CONTRACTED HEALTH PLAN.21

(C) ENSURE THAT ALL ENROLLEES DESCRIBED IN SUBDIVISION (A)22

HAVE ACCESS TO A PRIMARY CARE PHYSICIAN AND TO PREVENTIVE SERVICES.23

(D) REQUIRE ENROLLEES DESCRIBED IN SUBDIVISION (A) WITH ANNUAL24

INCOMES BETWEEN 100% TO 133% OF THE FEDERAL POVERTY GUIDELINES TO25

CONTRIBUTE NOT MORE THAN 5% OF INCOME FOR COST-SHARING26

REQUIREMENTS. CONTRIBUTIONS REQUIRED IN THIS SUBDIVISION DO NOT27


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APPLY FOR THE FIRST 6 MONTHS AN INDIVIDUAL DESCRIBED IN SUBDIVISION1

(A) IS ENROLLED. REQUIRED CONTRIBUTIONS TO AN ACCOUNT USED TO PAY2

FOR INCURRED HEALTH EXPENSES CAN BE REDUCED TO 0% IF HEALTHY3

BEHAVIORS ARE MET. CO-PAYS CANNOT BE REDUCED TO LESS THAN 2% OF4

INCOME. CONTRIBUTIONS MAY BE REDUCEDBYTHE CONTRACTED HEALTH PLAN5

BASED ON THE ENROLLEE'S ATTAINING SPECIFIC GOALS TO IMPROVE OR6

MAINTAIN HEALTHY BEHAVIORS THAT INCLUDE, BUT ARE NOT LIMITED TO,7

COMPLETING A DEPARTMENT OF COMMUNITY HEALTH-APPROVED ANNUAL HEALTH8

RISK ASSESSMENT TO IDENTIFY UNHEALTHY CHARACTERISTICS, INCLUDING9

ALCOHOL AND TOBACCO USE, OBESITY, AND IMMUNIZATION STATUS. IF THE10

ENROLLEE DESCRIBED IN SUBDIVISION (A) BECOMES INELIGIBLE FOR11

MEDICAL ASSISTANCE UNDER THE PROGRAM DESCRIBED IN THIS SECTION, ANY12

CONTRIBUTION MADE ON HIS OR HER BEHALF INTO THE ACCOUNT DESCRIBED13

IN SUBDIVISION (A) SHALL BE RETURNED TO THAT ENROLLEE IN THE FORM14

OF A VOUCHER TO PURCHASE PRIVATE INSURANCE.15

(E) DURING THE ENROLLMENT PROCESS, INFORM ENROLLEES DESCRIBED16

IN SUBDIVISION (A) ABOUT ADVANCE DIRECTIVES AND REQUIRE THE17

ENROLLEES TO COMPLETE A DEPARTMENT OF COMMUNITY HEALTH-APPROVED18

ADVANCE DIRECTIVE ON A FORM THAT INCLUDES AN OPTION TO DECLINE.19

(F) DEVELOP INCENTIVES FOR ENROLLEES WHO ASSIST THE DEPARTMENT20

OF COMMUNITY HEALTH IN DETECTING FRAUD AND ABUSE IN THE MEDICAL21

ASSISTANCE PROGRAM.22

(G) ALLOW FOR SERVICES PROVIDED THROUGH TELEMEDICINE.23

(2) ANY HOSPITAL THAT PARTICIPATES IN THE MEDICAL ASSISTANCE24

PROGRAM UNDER THIS ACT SHALL DISCOUNT CHARGES TO UNINSURED25

INDIVIDUALS WHO HAVE AN ANNUAL INCOME LEVEL UNDER 133% OF THE26

FEDERAL POVERTY GUIDELINES TO 115% OF RATES PAID BY MEDICARE.27


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(3) NOT MORE THAN 7 CALENDAR DAYS AFTER RECEIVING A WAIVER1

FROM THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES TO2

IMPLEMENT THE PROVISIONS OF THIS SECTION, THE DEPARTMENT OF3

COMMUNITY HEALTH SHALL SUBMIT A WRITTEN COPY OF THE APPROVED WAIVER4

PROVISIONS TO THE SENATE MAJORITY LEADER, THE SPEAKER OF THE HOUSE5

OF REPRESENTATIVES, AND THE SENATE AND HOUSE STANDING COMMITTEES ON6

MATTERS OF HEALTH FOR REVIEW.7

[(4) THE DEPARTMENT OF COMMUNITY HEALTH SHALL DEVELOP AND IMPLEMENT8A PLAN TO ENROLL ALL FEE-FOR-SERVICE ENROLLEES INTO CONTRACTED HEALTH9PLANS IF ALLOWABLE BY LAW AND IF THE MEDICAL ASSISTANCE PROGRAM IS THE10PRIMARY PAYER. THIS INCLUDES ALL NEWLY ELIGIBLE ENROLLEES AS DESCRIBED11

IN SUBSECTION (1)(A). THE DEPARTMENT OF COMMUNITY HEALTH IS DIRECTED TOINCLUDE CONTRACTED HEALTH PLANS AS THE MANDATORY DELIVERY SYSTEM IN ITSWAIVER REQUEST. THE DEPARTMENT OF COMMUNITY HEALTH ALSO SHALL PURSUE ANYAND ALL NECESSARY WAIVERS TO ENROLL PERSONS ELIGIBLE FOR BOTH MEDICAIDAND MEDICARE INTO MANAGED CARE BEGINNING JULY 1, 2014. BY SEPTEMBER 30,2015, THE DEPARTMENT OF COMMUNITY HEALTH SHALL IDENTIFY ALL REMAININGPOPULATIONS ELIGIBLE FOR MANAGED CARE AND DEVELOP PLANS FOR THEIRINTEGRATION INTO MANAGED CARE.]

(5) BY SEPTEMBER 30, 2016, THE DEPARTMENT OF COMMUNITY HEALTH12

SHALL IMPLEMENT A PHARMACEUTICAL BENEFIT THAT UTILIZES CO-PAYS AT13

APPROPRIATE LEVELS ALLOWABLE BY THE CENTERS FOR MEDICARE AND14

MEDICAID SERVICES TO ENCOURAGE THE USE OF HIGH-VALUE, LOW-COST15

PRESCRIPTIONS, SUCH AS GENERIC PRESCRIPTIONS AND 90-DAY16

PRESCRIPTION SUPPLIES, AS RECOMMENDED BY THE ENROLLEE'S PHYSICIAN.17

(6) THE DEPARTMENT OF COMMUNITY HEALTH SHALL WORK WITH18

PROVIDERS, CONTRACTED HEALTH PLANS, AND OTHER DEPARTMENTS AS19

NECESSARY TO CREATE PROCESSES THAT REDUCE THE AMOUNT OF UNCOLLECTED20

CO-PAYS AND DEDUCTIBLES FOR THE PROGRAM DESCRIBED IN THIS SECTION21

AND REDUCE THE ADMINISTRATIVE COST OF COLLECTING THOSE CO-PAYS AND22

DEDUCTIBLES.23

(7) THE PROGRAM DESCRIBED IN THIS SECTION SHALL INCLUDE24

INFORMATION REGARDING THE IMPACT ON THE HEALTH STATUS OF THE25

COVERED POPULATION OF ENROLLEES DESCRIBED IN SUBSECTION (1)(A)26

INCLUDING A TARGETED ASSESSMENT RELATED TO EMPLOYABILITY AND SHALL27


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PROMOTE EMPLOYMENT-RELATED SERVICES AND JOB TRAINING AVAILABLE TO1

LOWER THE MEDICAL ASSISTANCE PROGRAM CASELOADS BY ASSISTING ABLE-2

BODIED ADULT MEDICAL ASSISTANCE RECIPIENTS WHO ARE UNEMPLOYED INTO3

THE WORKFORCE. "ABLE-BODIED ADULT MEDICAL ASSISTANCE RECIPIENTS"4

MEANS ADULTS AGED 21 TO UNDER 65 WHO ARE NOT INCLUDED IN THE5

PROVISIONS OF42 CFR 440.315.6

(8) THE PROGRAM DESCRIBED IN THIS SECTION IS CREATED TO EXTEND7

HEALTH COVERAGE TO THIS STATE'S LOW-INCOME CITIZENS AND TO PROVIDE8

HEALTH INSURANCE COST RELIEF TO INDIVIDUALS AND TO THE BUSINESS9

COMMUNITY BY REDUCING THE COST SHIFT OF UNCOMPENSATED CARE. TO THAT10

END, THE DEPARTMENT OF COMMUNITY HEALTH SHALL EXAMINE THE FINANCIAL11

REPORTS OF HOSPITALS AND EVALUATE THE IMPACT THAT PROVIDING MEDICAL12

COVERAGE TO THE EXPANDED POPULATION OF ENROLLEES DESCRIBED IN13

SUBSECTION (1)(A) HAS HAD ON UNCOMPENSATED CARE. BY DECEMBER 31,14

2014, THE DEPARTMENT OF COMMUNITY HEALTH SHALL MAKE AN INITIAL15

BASELINE REPORT TO THE LEGISLATURE REGARDING UNCOMPENSATED CARE AND16

EACH DECEMBER 31 AFTER THATSHALL MAKE A REPORT REGARDING THE17

EVIDENCE OF THE REDUCTION IN UNCOMPENSATED CARE COMPARED TO THE18

INITIAL BASELINE REPORT. BASED ON THE EVIDENCE OF THE REDUCTION IN19

UNCOMPENSATED CARE BORNE BY THE HOSPITALS IN THIS STATE, BEGINNING20

APRIL 1, 2015, THE DEPARTMENT OF COMMUNITY HEALTH SHALL21

PROPORTIONATELY REDUCE THE DISPROPORTIONATE SHARE PAYMENTS TO22

HOSPITALS FOR THE PURPOSE OF PRODUCING GENERAL FUND SAVINGS. THE23

DEPARTMENT OF COMMUNITY HEALTH SHALL RECOGNIZE ANY SAVINGS FROM24

THIS REDUCTION BY SEPTEMBER 30, 2016. ALL THE REPORTS REQUIRED25

UNDER THIS SUBSECTION SHALL BE MADE AVAILABLE TO THE LEGISLATURE26

AND SHALL BE MADE AVAILABLE AND EASILY ACCESSIBLE ON THE DEPARTMENT27


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OF COMMUNITY HEALTH'S AND THE LEGISLATURE'S WEBSITES.1

(9) THE DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES SHALL2

EXAMINE THE FINANCIAL REPORTS OF HEALTH INSURERS AND EVALUATE THE3

IMPACT THAT PROVIDING MEDICAL COVERAGE TO THE EXPANDED POPULATION4

OF ENROLLEES DESCRIBED IN SUBSECTION (1)(A) HAS HAD ON RATES. THE5

DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES SHALL CONSIDER THE6

EVALUATION DESCRIBED IN THIS SUBSECTION IN THE ANNUAL APPROVAL OF7

RATES. BY DECEMBER 31, 2014,THE DEPARTMENT OF INSURANCE AND8

FINANCIAL SERVICES SHALL MAKE AN INITIAL BASELINE REPORT TO THE9

LEGISLATURE REGARDING RATES AND EACH DECEMBER 31 AFTER THAT SHALL10

MAKE A REPORT REGARDING THE EVIDENCE OF THE REDUCTION IN RATES11

COMPARED TO THE INITIAL BASELINE REPORT. ALL THE REPORTS REQUIRED12

UNDER THIS SUBSECTION SHALL BE MADE AVAILABLE TO THE LEGISLATURE13

AND SHALL BE MADE AVAILABLE AND EASILY ACCESSIBLE ON THE DEPARTMENT14

OF COMMUNITY HEALTH'S AND THE LEGISLATURE'S WEBSITES.15

(10) THE DEPARTMENT OF COMMUNITY HEALTH SHALL EXPLORE AND16

DEVELOP A RANGE OF INNOVATIONS AND INITIATIVES TO IMPROVE THE17

EFFECTIVENESS AND PERFORMANCE OF THE MEDICAL ASSISTANCE PROGRAM AND18

TO LOWER OVERALL HEALTH CARE COSTS IN THIS STATE. THE DEPARTMENT OF19

COMMUNITY HEALTH SHALL REPORT THE RESULTS OF THE EFFORTS DESCRIBED20

IN THIS SUBSECTION TO THE CHAIRS OF THE HOUSE AND SENATE21

APPROPRIATION SUBCOMMITTEES ON DEPARTMENT OF COMMUNITY HEALTH22

MATTERS AND TO THE HOUSE AND SENATE FISCAL AGENCIES BY SEPTEMBER23

30, 2015. THE REPORT REQUIRED UNDER THIS SUBSECTION SHALL ALSO BE24

MADE AVAILABLE AND EASILY ACCESSIBLE ON THE DEPARTMENT OF COMMUNITY25

HEALTH'S AND THE LEGISLATURE'S WEBSITES. THE DEPARTMENT OF26

COMMUNITY HEALTH SHALL PURSUE A BROAD RANGE OF INNOVATIONS AND27


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INITIATIVES AS TIME AND RESOURCES ALLOW. HOWEVER, THESE INNOVATIONS1

AND INITIATIVES SHALL INCLUDE, AT A MINIMUM, ALL OF THE FOLLOWING:2

(A) THE VALUE AND COST-EFFECTIVENESS OF OPTIONAL MEDICAID3

BENEFITS AS DESCRIBED IN FEDERAL STATUTE.4

(B) THE IDENTIFICATION OF PRIVATE SECTOR, PRIMARILY SMALL5

BUSINESS, BENEFIT DIFFERENCES COMPARED TO THE MEDICAL ASSISTANCE6

PROGRAM SERVICES AND JUSTIFICATION FOR THE DIFFERENCES.7

(C) THE MINIMUM MEASURES AND DATA SETS REQUIRED TO EFFECTIVELY8

MEASURE THE MEDICAL ASSISTANCE PROGRAM'S RETURN ON INVESTMENT FOR9

TAXPAYERS.10

(D) REVIEW AND EVALUATION OF THE EFFECTIVENESS OF CURRENT11

INCENTIVES FOR CONTRACTED HEALTH PLANS, PROVIDERS, AND12

BENEFICIARIES WITH RECOMMENDATIONS FOR EXPANDING AND REFINING13

INCENTIVES TO ACCELERATE IMPROVEMENT IN HEALTH OUTCOMES, HEALTHY14

BEHAVIORS, AND COST-EFFECTIVENESS.15

(E) REVIEW AND EVALUATION OF THE CURRENT DESIGN PRINCIPLES16

THAT SERVE AS THE FOUNDATION FOR THE STATE'S MEDICAL ASSISTANCE17

PROGRAM.18

(11) BY JANUARY 1, 2014, THE DEPARTMENT OF COMMUNITY HEALTH19

AND THE CONTRACTED HEALTH PLANS IN COLLABORATION WITH PROVIDERS20

SHALL CREATE FINANCIAL INCENTIVES FOR ALL OF THE FOLLOWING:21

(A) CONTRACTED HEALTH PLANS THAT MEET SPECIFIED POPULATION22

IMPROVEMENT GOALS.23

(B) PROVIDERS WHO MEET SPECIFIED QUALITY AND COST TARGETS.24

(C) ENROLLEES WHO DEMONSTRATE IMPROVED HEALTH OUTCOMES OR25

MAINTAIN HEALTHY BEHAVIORS AS IDENTIFIED IN A HEALTH RISK26

ASSESSMENT AS IDENTIFIED BY THEIR PRIMARY CARE PRACTITIONER.27


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(12) THE DEPARTMENT OF COMMUNITY HEALTH SHALL ENSURE THAT ALL1

CAPITATED PAYMENTS MADE TO CONTRACTED HEALTH PLANS ARE ACTUARIALLY2

SOUND.3

(13) THE DEPARTMENT OF COMMUNITY HEALTH SHALL MAINTAIN4

ADMINISTRATIVE COSTS AT A LEVEL OF NOT MORE THAN 1% OF THE5

DEPARTMENT OF COMMUNITY HEALTH'S PORTION OF THE STATE MEDICAL6

ASSISTANCE PROGRAM. THESE ADMINISTRATIVE COSTS SHALL BE CAPPED AT7

THE TOTAL ADMINISTRATIVE COSTS FOR THE FISCAL YEAR ENDING SEPTEMBER8

30, 2016, EXCEPT FOR INFLATION AND PROJECT-RELATED COSTS REQUIRED9

TO ACHIEVE MEDICAL ASSISTANCE SAVINGS.10

(14) THE DEPARTMENT OF COMMUNITY HEALTH SHALL REQUIRE11

CONTRACTED HEALTH PLANS TO HAVE PROCEDURES AND COMPLIANCE METRICS12

FOR CONTRIBUTION PAYMENTS TO ENSURE THAT CONTRIBUTION REQUIREMENTS13

ARE BEING MET.14

(15) THE DEPARTMENT OF COMMUNITY HEALTH SHALL MEASURE15

CONTRACTED HEALTH PLAN PERFORMANCE ON APPLICATION OF STANDARDS OF16

CARE AS THAT RELATES TO APPROPRIATE TREATMENT OF SUBSTANCE ABUSE.17

(16) IF A WAIVER REQUESTED UNDER THIS SECTION IS NOT APPROVED18

BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES BY19

DECEMBER 31, 2015, MEDICAL COVERAGE FOR INDIVIDUALS DESCRIBED IN20

SUBSECTION (1)(A) SHALL NO LONGER BE PROVIDED. IF THE WAIVER IS NOT21

APPROVED BY DECEMBER 31, 2015, THEN BY JANUARY 31, 2016, THE22

DEPARTMENT OF COMMUNITY HEALTH SHALL NOTIFY ENROLLEES THAT THE23

PROGRAM DESCRIBED IN SUBSECTION (1) SHALL BE TERMINATED ON APRIL24

30, 2016. INDIVIDUALS WHO ARE ELIGIBLE UNDER 42 CFR 440.315 ARE NOT25

SUBJECT TO THE PROVISIONS OF THE WAIVER. THE WAIVER MUST ALLOW26

INDIVIDUALS WHO HAVE HAD MEDICAL ASSISTANCE COVERAGE FOR 4827


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CUMULATIVE MONTHS BEGINNING ON THE DATE OF THEIR ENROLLMENT UNDER1

SUBSECTION (1)(A) AND WHO ARE BETWEEN 100% TO 133% OF THE FEDERAL2

POVERTY GUIDELINES TO CHOOSE TO DO EITHER OF THE FOLLOWING:3

(A) PURCHASE PRIVATE INSURANCE COVERAGE THROUGH AN EXCHANGE4

OPERATED IN THIS STATE AND BE CONSIDERED ELIGIBLE FOR FEDERAL5

SUBSIDIES BY THE FEDERAL GOVERNMENT.6

(B) REMAIN IN THE MEDICAL ASSISTANCE PROGRAM BUT INCREASE7

COST-SHARING REQUIREMENTS UP TO 7% OF INCOME. REQUIRED8

CONTRIBUTIONS TO AN ACCOUNT USED TO PAY FOR INCURRED HEALTH9

EXPENSES CAN BE REDUCED TO 0%. CO-PAYS CANNOT BE REDUCED TO LESS10

THAN 3% OF INCOME.11

(17) THE DEPARTMENT OF COMMUNITY HEALTH SHALL MAKE AVAILABLE12

AT LEAST 3 YEARS OF STATE MEDICAL ASSISTANCE PROGRAM DATA, WITHOUT13

CHARGE, TO ANY VENDOR CONSIDERED QUALIFIED BY THE DEPARTMENT OF14

COMMUNITY HEALTH WHO INDICATES INTEREST IN SUBMITTING PROPOSALS TO15

CONTRACTED HEALTH PLANS IN ORDER TO IMPLEMENT COST SAVINGS AND16

POPULATION HEALTH IMPROVEMENT OPPORTUNITIES THROUGH THE USE OF17

INNOVATIVE INFORMATION AND DATA MANAGEMENT TECHNOLOGIES. ANY18

PROGRAM OR PROPOSAL TO THE CONTRACTED HEALTH PLANS MUST BE19

CONSISTENT WITH THE STATE'S GOALS OF IMPROVING HEALTH, INCREASING20

THE QUALITY, RELIABILITY, AVAILABILITY, AND CONTINUITY OF CARE, AND21

REDUCING THE COST OF CARE OF THE ELIGIBLE POPULATION OF ENROLLEES22

DESCRIBED IN SUBSECTION (1)(A). THE USE OF THE DATA DESCRIBED IN23

THIS SUBSECTION FOR THE PURPOSE OF ASSESSING THE POTENTIAL24

OPPORTUNITY AND SUBSEQUENT DEVELOPMENT AND SUBMISSION OF FORMAL25

PROPOSALS TO CONTRACTED HEALTH PLANS IS NOT A COST OR CONTRACTUAL26

OBLIGATION TO THE DEPARTMENT OF COMMUNITY HEALTH OR THE STATE.27


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(18) IN ORDER TO CONTINUE WITH THE REFORM AND EXPANSION1

PROGRAM DESCRIBED IN THIS SECTION BEYOND DECEMBER 31, 2015, THE2

DEPARTMENT OF COMMUNITY HEALTH MUST RECEIVE FULL WAIVER APPROVAL3

BEFORE DECEMBER 31, 2015. IF THE DEPARTMENT OF COMMUNITY HEALTH HAS4

NOT RECEIVED FULL WAIVER APPROVAL BY DECEMBER 31, 2013, THE5

DEPARTMENT OF COMMUNITY HEALTH SHALL REQUEST WRITTEN DOCUMENTATION6

FROM THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES BY7

DECEMBER 31, 2013 THAT IF THE WAIVERS DESCRIBED IN THIS SECTION ARE8

REJECTED CAUSING THE MEDICAL ASSISTANCE PROGRAM TO REVERT BACK TO9

THE ELIGIBILITY REQUIREMENTS IN EFFECT ON THE EFFECTIVE DATE OF THE10

AMENDATORY ACT THAT ADDED THIS SECTION, THERE WILL BE NO FINANCIAL11

FEDERAL FUNDING PENALTY.12

(19) AS USED IN THIS SECTION, "TELEMEDICINE" MEANS THAT TERM13

AS DEFINED IN SECTION 3476 OF THE INSURANCE CODE OF 1956, 1956 PA14

218, MCL 500.3476.15

Sec. 106. (1) A medically indigent individual is defined as:16

(a) An individual receiving family independence program17

benefits or an individual receiving supplemental security income18

under title XVI or state supplementation under title XVI subject to19

limitations imposed by the director according to title XIX.20

(b) Except as provided in section 106a, an individual who21

meets all of the following conditions:22

(i) The individual has applied in the manner the family23

independence agency DEPARTMENT OF COMMUNITY HEALTH prescribes.24

(ii) The individual's need for the type of medical assistance25

available under this act for which the individual applied has been26

professionally established and payment for it is not available27


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through the legal obligation of a public or private contractor to1

pay or provide for the care without regard to the income or2

resources of the patient. The state department is AND THE3

DEPARTMENT OF COMMUNITY HEALTH ARE subrogated to any right of4

recovery that a patient may have for the cost of hospitalization,5

pharmaceutical services, physician services, nursing services, and6

other medical services not to exceed the amount of funds expended7

by the state department OR THE DEPARTMENT OF COMMUNITY HEALTH for8

the care and treatment of the patient. The patient or other person9

acting in the patient's behalf shall execute and deliver an10

assignment of claim or other authorizations as necessary to secure11

the right of recovery to the department OR THE DEPARTMENT OF12

COMMUNITY HEALTH. A payment may be withheld under this act for13

medical assistance for an injury or disability for which the14

individual is entitled to medical care or reimbursement for the15

cost of medical care under sections 3101 to 3179 of the insurance16

code of 1956, 1956 PA 218, MCL 500.3101 to 500.3179, or under17

another policy of insurance providing medical or hospital benefits,18

or both, for the individual unless the individual's entitlement to19

that medical care or reimbursement is at issue. If a payment is20

made, the state department OR THE DEPARTMENT OF COMMUNITY HEALTH,21

to enforce its subrogation right, may do either of the following:22

(a) intervene or join in an action or proceeding brought by the23

injured, diseased, or disabled individual, the individual's24

guardian, personal representative, estate, dependents, or25

survivors, against the third person who may be liable for the26

injury, disease, or disability, or against contractors, public or27


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private, who may be liable to pay or provide medical care and1

services rendered to an injured, diseased, or disabled individual;2

(b) institute and prosecute a legal proceeding against a third3

person who may be liable for the injury, disease, or disability, or4

against contractors, public or private, who may be liable to pay or5

provide medical care and services rendered to an injured, diseased,6

or disabled individual, in state or federal court, either alone or7

in conjunction with the injured, diseased, or disabled individual,8

the individual's guardian, personal representative, estate,9

dependents, or survivors. The state department may institute the10

proceedings in its own name or in the name of the injured,11

diseased, or disabled individual, the individual's guardian,12

personal representative, estate, dependents, or survivors. As13

provided in section 6023 of the revised judicature act of 1961,14

1961 PA 236, MCL 600.6023, the state department OR THE DEPARTMENT15

OF COMMUNITY HEALTH, in enforcing its subrogation right, shall not16

satisfy a judgment against the third person's property that is17

exempt from levy and sale. The injured, diseased, or disabled18

individual may proceed in his or her own name, collecting the costs19

without the necessity of joining the state department,THE20

DEPARTMENT OF COMMUNITY HEALTH, or the state as a named party. The21

injured, diseased, or disabled individual shall notify the state22

department OR THE DEPARTMENT OF COMMUNITY HEALTH of the action or23

proceeding entered into upon commencement of the action or24

proceeding. An action taken by the state, or the state department,25

OR THE DEPARTMENT OF COMMUNITY HEALTH in connection with the right26

of recovery afforded by this section does not deny the injured,27


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diseased, or disabled individual any part of the recovery beyond1

the costs expended on the individual's behalf by the state2

department OR THE DEPARTMENT OF COMMUNITY HEALTH. The costs of3

legal action initiated by the state shall be paid by the state. A4

payment shall not be made under this act for medical assistance for5

an injury, disease, or disability for which the individual is6

entitled to medical care or the cost of medical care under the7

worker's disability compensation act of 1969, 1969 PA 317, MCL8

418.101 to 418.941; except that payment may be made if an9

appropriate application for medical care or the cost of the medical10

care has been made under the worker's disability compensation act11

of 1969, 1969 PA 317, MCL 418.101 to 418.941, entitlement has not12

been finally determined, and an arrangement satisfactory to the13

state department OR THE DEPARTMENT OF COMMUNITY HEALTH has been14

made for reimbursement if the claim under the worker's disability15

compensation act of 1969, 1969 PA 317, MCL 418.101 to 418.941, is16

finally sustained.17

(iii) The individual has an annual income that is below, or18

subject to limitations imposed by the director and because of19

medical expenses falls below, the protected basic maintenance20

level. The protected basic maintenance level for 1-person and 2-21

person families shall be at least 100% of the payment standards22

generally used to determine eligibility in the family independence23

program. For families of 3 or more persons, the protected basic24

maintenance level shall be at least 100% of the payment standard25

generally used to determine eligibility in the family independence26

program. These levels shall recognize regional variations and shall27


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supplemental security income under title XVI or for state1

supplementation under the act, subject to limitations imposed by2

the director OF THE DEPARTMENT OF COMMUNITY HEALTH according to3

title XIX; or meets the eligibility standards for family4

independence program benefits; or meets the eligibility standards5

for optional eligibility groups under title XIX, subject to6

limitations imposed by the director OF THE DEPARTMENT OF COMMUNITY7

HEALTH according to title XIX.8

(C) AN INDIVIDUAL IS ELIGIBLE UNDER SECTION9

1396A(A)(10)(A)(I)(VIII) OF TITLE XIX. THIS SUBDIVISION DOES NOT10

APPLY IF EITHER OF THE FOLLOWING OCCURS:11

(i) IF THE DEPARTMENT OF COMMUNITY HEALTH IS UNABLE TO OBTAIN A12

FEDERAL WAIVER AS PROVIDED IN SECTION 105D.13

[(ii) IF FEDERAL GOVERNMENT MATCHING FUNDS FOR THE PROGRAM14

DESCRIBED IN SECTION 105D ARE REDUCED BELOW 100% AND ANNUAL STATE15

SAVINGS AND OTHER SAVINGS ASSOCIATED WITH THE IMPLEMENTATION OF THAT16

PROGRAM ARE NOT SUFFICIENT TO COVER THE REDUCED FEDERAL MATCH. THE17

DEPARTMENT OF COMMUNITY HEALTH SHALL DETERMINE HOW ANNUAL STATE SAVINGS18

AND OTHER SAVINGS WILL BE CALCULATED BY JUNE 1, 2014.]

(2) As used in this act:19

(a) "Medicaid contracted "CONTRACTED health plan" means a20

managed care organization with whom the state department OR THE21

DEPARTMENT OF COMMUNITY HEALTH contracts to provide or arrange for22

the delivery of comprehensive health care services as authorized23

under this act.24

(B) "FEDERAL POVERTY GUIDELINES" MEANS THE POVERTY GUIDELINES25

PUBLISHED ANNUALLY IN THE FEDERAL REGISTER BY THE UNITED STATES26

DEPARTMENT OF HEALTH AND HUMAN SERVICES UNDER ITS AUTHORITY TO27


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REVISE THE POVERTY LINE UNDER SECTION 673(2) OF SUBTITLE B OF TITLE1

VI OF THE OMNIBUS BUDGET RECONCILIATION ACT OF 1981, 42 USC 9902.2

(C) (b) "Medical institution" means a state licensed or3

approved hospital, nursing home, medical care facility, psychiatric4

hospital, or other facility or identifiable unit of a listed5

institution certified as meeting established standards for a6

nursing home or hospital in accordance with the laws of this state.7

(D) (c) "Title XVI" means title XVI of the social security8

act, 42 USC 1381 to 1382j and 1383 to 1383f.9

(3) An individual receiving medical assistance under this act10

or his or her legal counsel shall notify the state department OR11

THE DEPARTMENT OF COMMUNITY HEALTH when filing an action in which12

the state department OR THE DEPARTMENT OF COMMUNITY HEALTH may have13

a right to recover expenses paid under this act. If the individual14

is enrolled in a medicaid contracted health plan, the individual or15

his or her legal counsel shall provide notice to the medicaid16

contracted health plan in addition to providing notice to the state17

department.18

(4) If a legal action in which the state department, THE19

DEPARTMENT OF COMMUNITY HEALTH, a medicaid contracted health plan,20

or both has ALL 3 HAVE a right to recover expenses paid under this21

act is filed and settled after November 29, 2004 without notice to22

the state department,THE DEPARTMENT OF COMMUNITY HEALTH, or the23

medicaid contracted health plan, the state department,THE24

DEPARTMENT OF COMMUNITY HEALTH, or the medicaid contracted health25

plan may file a legal action against the individual or his or her26

legal counsel, or both, to recover expenses paid under this act.27


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The attorney general shall recover any cost or attorney fees1

associated with a recovery under this subsection.2

(5) The state department OR THE DEPARTMENT OF COMMUNITY HEALTH3

has first priority against the proceeds of the net recovery from4

the settlement or judgment in an action settled in which notice has5

been provided under subsection (3). A medicaid contracted health6

plan has priority immediately after the state department OR THE7

DEPARTMENT OF COMMUNITY HEALTH in an action settled in which notice8

has been provided under subsection (3). The state department,THE9

DEPARTMENT OF COMMUNITY HEALTH, and a medicaid contracted health10

plan shall recover the full cost of expenses paid under this act11

unless the state department,THE DEPARTMENT OF COMMUNITY HEALTH, or12

the medicaid contracted health plan agrees to accept an amount less13

than the full amount. If the individual would recover less against14

the proceeds of the net recovery than the expenses paid under this15

act, the state department,THE DEPARTMENT OF COMMUNITY HEALTH, or16

medicaid contracted health plan, and the individual shall share17

equally in the proceeds of the net recovery. As used in this18

subsection, "net recovery" means the total settlement or judgment19

less the costs and fees incurred by or on behalf of the individual20

who obtains the settlement or judgment.21

Sec. 107. (1) In establishing financial eligibility for the22

medically indigent, as defined in section 106, income shall be23

disregarded in accordance with standards established for the24

related categorical assistance program. For medical assistance25

only, income shall include the amount of contribution that an26

estranged spouse or parent for a minor child is making to the27


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applicant according to the standards of the state department OF1

COMMUNITY HEALTH, or according to a court determination, if there2

is a court determination. Nothing in this section eliminates the3

responsibility of support established in section 76 for cash4

assistance received under this act.5

(2) THE DEPARTMENT OF COMMUNITY HEALTH SHALL APPLY A MODIFIED6

ADJUSTED GROSS INCOME METHODOLOGY IN DETERMINING IF AN INDIVIDUAL'S7

ANNUAL INCOME LEVEL IS BELOW 133% OF THE FEDERAL POVERTY8

GUIDELINES. THIS SUBSECTION DOES NOT APPLY IF EITHER OF THE9

FOLLOWING OCCURS:10

(A) IF THE DEPARTMENT OF COMMUNITY HEALTH IS UNABLE TO OBTAIN11

A FEDERAL WAIVER AS PROVIDED IN SECTION 105D.12

[(B) IF FEDERAL GOVERNMENT MATCHING FUNDS FOR THE PROGRAM DESCRIBED13

IN SECTION 105D ARE REDUCED BELOW 100% AND ANNUAL STATE SAVINGS AND14

OTHER SAVINGS ASSOCIATED WITH THE IMPLEMENTATION OF THAT PROGRAM ARE NO15

SUFFICIENT TO COVER THE REDUCED FEDERAL MATCH. THE DEPARTMENT OF16

COMMUNITY HEALTH SHALL DETERMINE HOW ANNUAL STATE SAVINGS AND OTHER17

SAVINGS WILL BE CALCULATED BY JUNE 1, 2014.]

Sec. 108. A medically indigent person as defined under18

subdivision (1) of section 106, 106(1) is entitled to all the19

services enumerated in subsections (a), (b), (c), (d), (e) and (f)20

of section 109. A medically indigent person as defined under21

subdivision (2) of section 106 106(2) is entitled to medical22

services enumerated in subsections (a), (c) and (e) of section 109.23

SECTION 109(A), (C), AND (E). He shall also be OR SHE IS entitled24

to the services enumerated in subsections (b), SECTION 109(B), (d),25

and (f) of section 109 to the extent of appropriations made26

available by the legislature for the fiscal year. Medical services27


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shall be rendered upon certification by the attending licensed1

physician and dental services shall be rendered upon certification2

of the attending licensed dentist that a service is required for3

the treatment of an individual. The services of a medical4

institution shall be rendered only after referral by a licensed5

physician or dentist and certification by him OR HER that the6

services of the medical institution are required for the medical or7

dental treatment of the individual, except that referral is not8

necessary in case of an emergency. Periodic recertification that9

medical treatment which THAT extends over a period of time is10

required in accordance with regulations of the state department11

shall be OF COMMUNITY HEALTH IS a condition of continuing12

eligibility to receive medical assistance. To comply with federal13

statutes governing medicaid, the state department OF COMMUNITY14

HEALTH shall provide such early and periodic screening, diagnostic15

and treatment services to eligible children as it deems CONSIDERS16

necessary.17

Sec. 109c. (1) The state department OF COMMUNITY HEALTH shall18

include, as part of its program of medical services under this act,19

home- or community-based services to eligible persons whom the20

state department OF COMMUNITY HEALTH determines would otherwise21

require nursing home services or similar institutional care22

services under section 109. The home- or community-based services23

shall be offered to qualified eligible persons who are receiving24

inpatient hospital or nursing home services as an alternative to25

those forms of care.26

(2) The home- or community-based services shall include27


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safeguards adequate to protect the health and welfare of1

participating eligible persons, and shall be provided according to2

a written plan of care for each person. The services available3

under the home- or community-based services program shall include,4

at a minimum, all of the following:5

(a) Home delivered meals.6

(b) Chore services.7

(c) Homemaker services.8

(d) Respite care.9

(e) Personal care.10

(f) Adult day care.11

(g) Private duty nursing.12

(h) Mental health counseling.13

(i) Caregiver training.14

(j) Emergency response systems.15

(k) Home modification.16

(l) Transportation.17

(m) Medical equipment and supply services.18

(3) This section shall be implemented so that the average per19

capita expenditure for home- or community-based services for20

eligible persons receiving those services does not exceed the21

estimated average per capita expenditure that would have been made22

for those persons had they been receiving nursing home services,23

inpatient hospital or similar institutional care services instead.24

(4) The state department OF COMMUNITY HEALTH shall seek a25

waiver necessary to implement this program from the federal26

department of health and human services, as provided in section27


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1915 of title XIX, 42 U.S.C. USC 1396n. The department OF COMMUNITY1

HEALTH shall request any modifications of the waiver that are2

necessary in order to expand the program in accordance with3

subsection (9).4

(5) The state department OF COMMUNITY HEALTH shall establish5

policy for identifying the rules for persons receiving inpatient6

hospital or nursing home services who may qualify for home- or7

community-based services. The rules shall contain, at a minimum, a8

listing of diagnoses and patient conditions to which the option of9

home- or community-based services may apply, and a procedure to10

determine if the person qualifies for home- or community-based11

services.12

(6) The state department OF COMMUNITY HEALTH shall provide to13

the legislature and the governor an annual report showing the14

detail of its home- and community-based case finding and placement15

activities. At a minimum, the report shall contain each of the16

following:17

(a) The number of persons provided home- or community-based18

services who would otherwise require inpatient hospital services.19

This shall include a description of medical conditions, services20

provided, and projected cost savings for these persons.21

(b) The number of persons provided home- or community-based22

services who would otherwise require nursing home services. This23

shall include a description of medical conditions, services24

provided, and projected cost savings for these persons.25

(c) The number of persons and the annual expenditure for26

personal care services.27


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(d) The number of hearings requested concerning home- or1

community-based services and the outcome of each hearing which has2

been adjudicated during the year.3

(7) The written plan of care required under subsection (2) for4

an eligible person shall not be changed unless the change is5

prospective only, and the state department OF COMMUNITY HEALTH does6

both of the following:7

(a) Not later than 30 days before making the change, except in8

the case of emergency, consults with the eligible person or, in the9

case of a child, with the child's parent or guardian.10

(b) Consults with each medical service provider involved in11

the change. This consultation shall be documented in writing.12

(8) An eligible person who is receiving home- or community-13

based services under this section, and who is dissatisfied with a14

change in his or her plan of care or a denial of any home- or15

community-based service, may demand a hearing as provided in16

section 9, and subsequently may appeal the hearing decision to17

circuit court as provided in section 37.18

(9) The state department OF COMMUNITY HEALTH shall expand the19

home- and community-based services program by increasing the number20

of counties in which it is available, in conformance with this21

subsection. The program may be limited in total cost and in the22

number of recipients per county who may receive services at 1 time.23

Subject to obtaining the waiver and any modifications of the waiver24

sought under subsection (4), the program shall be expanded as25

follows:26

(a) Not later than 1 year after the effective date of this27


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subsection, JULY 14, 1995, home- and community-based services shall1

be available to eligible applicants in those counties that, when2

combined, contain at least 1/4 of the population of this state.3

(b) Not later than 2 years after the effective date of this4




(c) Not later than 3 years after the effective date of this8




(d) Not later than 4 years after the effective date of this12


be available to eligible applicants on a statewide basis.14

(10) The state department OF COMMUNITY HEALTH shall work with15

the office of services to the aging in implementing the home- and16

community-based services program, including the provision of17

preadmission screening, case management, and recipient access to18

services.19

Enacting section 1. This amendatory act does not do either of20

the following:21

(a) Authorize the establishment or operation of a state-22

created American health benefit exchange in this state related to23

the patient protection and affordable care act, Public Law 111-148,24

as amended by the federal health care and education reconciliation25

act of 2010, Public Law 111-152.26

(b) Convey any additional statutory, administrative, rule-27


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making, or other power to this state or an agency of this state1

that did not exist before the effective date of the amendatory act2

that added section 105d to the social welfare act, 1939 PA 280, MCL3

400.105d, that would authorize, establish, or operate a state-4

created American health benefit exchange.5

Medicaid Expansion bill HB 4714 as passed by the House (2013)

Documents